Obesity increases risk for COVID-19 ICU admission, but not mortality
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Obesity is associated with a greater risk for ICU admission, but not mortality, in COVID-19 patients admitted to a five-hospital health system in the Northeast, according to a presenter at the ENDO annual meeting.
“[The findings] underscore the vulnerability of individuals with obesity during the current pandemic and emphasize the need to ensure that obesity is given appropriate consideration in COVID-19 prevention and management,” Yu Mi Kang, MD, PhD, a resident physician in the department of internal medicine at Yale New Haven Health’s Bridgeport Hospital, said during a press conference.
Kang and colleagues extracted data from the Yale New Haven Health System on adults hospitalized with COVID-19 from March 10 to Sept. 1, 2020. BMI was calculated for each patient using height and weight data. Obesity was defined as having a BMI of 30 kg/m2 or greater, and those with obesity were placed into class I, class II and class III obesity subgroups based on WHO classification. The primary endpoints were death or hospice care, ICU admission and duration of ICU stay.
There were 3,246 adults included in the study, of whom 43.2% had obesity and 30.5% were classified as overweight. Only 23.5% of hospitalized patients had normal weight, and 2.8% had underweight.
One-quarter of all participants were admitted to the ICU during the study period. In adjusted data, people with obesity hospitalized with COVID-19 had a higher likelihood for ICU admission compared with those of normal weight (adjusted OR = 1.27; 95% CI, 1.07-1.51). The odds for ICU admission were even greater for people with class II obesity (aOR = 1.48; 95% CI, 1.1-1.99) and class III obesity (aOR = 2.07; 95% CI, 1.51-2.82) compared with normal weight.
People in the normal-weight group admitted to the ICU had a mean length of stay of 6.6 days, whereas those with obesity stayed in the ICU for a mean of 9.5 days. The mean length of stay in the ICU increased with each obesity class: 9.1 days for adults with class I obesity, 9.3 days with class II, and 10.2 days with class III.
Of the study cohort, 16.7% died or received hospice care during the study period. After adjusting for confounders, obesity was not associated with an increased risk for in-hospital death and hospice care. No increased risk for COVID-19 mortality was observed in any of the three obesity classes, or the overweight or underweight subgroups.
Kang said there may be a few reasons why obesity was not associated with an increased risk for COVID-19 mortality.
“We were fortunate to have more lead time to gather up resources and learn from other countries and states’ experiences that were struck by the pandemic first,” Kang said. “These led us to hire more health care providers, expand floor and ICU beds with negative pressure equipment, and gather all ventilators throughout the health care system. In addition to that, we see frequent updates on COVID-19 management protocols by our health system. These were mainly based on the rapidly emerging reports from those other states.”
Kang added there was a larger proportion of patients with obesity who were administered steroids, atezolizumab (Tecentriq, Genentech) and remdesivir (Veklury, Gilead Sciences) compared with adults with normal weight, which may have mitigated the mortality rate, although she said more investigation is needed.
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Kang YM, et al. Obesity is associated with intensive care use and duration of ICU stay but not mortality among 3,246 patients hospitalized with COVID-19. Presented at: ENDO Annual Meeting; March 20-23, 2021 (virtual meeting).
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